What can pharmacology learn from psychology and vice versa?

Simon Blackwell: Most people would agree that ‘mind’ and ‘body’ are closely interlinked, and when it comes to the brain, there’s no real difference between ‘psychological’ and ‘biological’ – they are just different ways of explaining the same phenomena. However, for historical reasons these areas have generally been researched in isolation.

Matt Field: Psychology can be very informative for the development of medications in mental health. Once a medication is developed and we can show that it affects the core symptoms of a condition (e.g. depressed mood in major depression), it is important to go beyond the molecular level if we are to fully explain how the medication works. For example, work conducted over the previous 15 years or so has demonstrated that antidepressant drugs lead to subtle changes a person’s thought processes, and these changes in turn are predictive of improvements in mood. At the moment, despite having effective medications for many other mental health conditions (e.g. schizophrenia or addiction), we don’t have such good knowledge of their psychological mechanism of action.

Martina Di Simplico: Sometimes the manipulation of pharmacological (neurotransmitter) pathways appears to elicit quite contradictory effects; using cognitive models may actually help unpack data from pharmacological research. This can help understand how a drug initially can increase anxiety by making someone more alert to stimuli, but the same drug can help in the long term once the increased alertness helps overcome the avoidance that maintains anxiety.

Simon Blackwell: Often researchers in pharmacology and psychology are studying the same broad phenomena, and just understanding a bit more about how the problem you’re researching is investigated and explained by someone using a different level of explanation (e.g. genetics, neurochemical, cognitive science) can provide new insights. We can also learn a lot by studying each other’s research methodologies – are there procedures and processes commonly used in one field that could be hugely valuable if applied in the other?

How will the collaboration of these two disciplines affect people’s lives?

Simon Blackwell: Collaboration between these two disciplines should help to put the patient in the centre. This should also help to dispel the idea that pharmacological and psychological approaches are somehow in opposition to each other, or that pharmacological and psychological explanations, for example of depression, are somehow mutually exclusive. Instead, collaboration can help spread the idea that these are simply different routes to a common endpoint – improved mental health.

Matt Field: Regardless of their ultimate cause (heritability, environmental factors etc.), the final common path to most, if not all, mental health conditions is cognition – the way that people think. The challenge is to identify cognitive processes that have the most important causal influences on mental health conditions (e.g. feelings of helplessness or irresistible cravings in addiction, or uncontrollable worry in generalised anxiety). Some disordered cognitions might be particularly sensitive to psychological interventions, others to medications, but it’s likely that many will be sensitive to the combination of the two.

Martina Di Simplico: Understanding that psychological and chemical mechanisms are just different levels of description of our mental experiences (including illness symptoms) will help overcome the dichotomy between drugs and talking therapies. It’s like different routes to the same target and they can be complementary or we could find out when and for whom it’s preferable to take one, the other or both.

What are the most exciting advances you anticipate coming from interdisciplinary research in mental health over the next 10 years?

Simon Blackwell: I think we will see the development of “next generation” treatment approaches that focus on targeting key mechanisms – whether via a psychological or pharmacological intervention, or a combination. These could be much briefer interventions that may look very different from current treatment approaches. Interdisciplinary research in mental health could also help us make huge advances in the development of better tools to inform clinical decision-making, such as what intervention to use for a particular individual, and how to know if the chosen treatment is in fact working.

Matt Field: In my own field of addiction, I believe that we are moving closer to a more complete understanding of the core psychological dysfunctions that underlie the development of the disorder. We are also starting to see how these dysfunctions (and accompanying brain activity) change when people recover from addictions. Very recent and ongoing research is identifying how some core processes, such as deficient self-control, might be targeted by novel medications, talking therapies, and by novel cognitive interventions such as inhibition training. It will be really interesting to investigate if specific combinations of novel medications and cognitive or behavioural interventions can lead to more pronounced and long-lasting changes in these core cognitive processes.

Martina Di Simplico: The most exciting advances could be for young people and developing preventative interventions, through understanding why mental processes may develop in a non-adaptive way and intervening early.